We have begun multicenter testing of mitral cerclage annuloplasty to treat secondary mitral regurgitation in patients in the USA. We have continued preclinical development with an industry partner for our transauricular intrapericardial tricuspid annuloplasty (TRAIPTA) technique and device to treat secondary tricuspid regurgitation. We expect to begin USA early feasibility testing next year. We completed enrollment and primary reporting of a multicenter early feasibility study of a dedicated closure device for transcaval access developed by NHLBI in partnership with a small business. We completed enrollment and reporting of a multicenter early feasibility study of Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction after TAVR (BASILICA). We are leading education and proctorship, directly and in industry partnership, for this technique which has been applied to hundreds of patients worldwide. We completed enrollment and reporting of a multicenter early feasibility study of intentional Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow ObstructioN (LAMPOON) after transcatheter mitral valve replacement. We have led education efforts. The technique has been applied to hundreds of patients worldwide. We developed and reported a LAMPOON-variant to allow TMVR after Alfieri-stitch (ELASTIC) and after mitra-clip (ELASTA-a-CLIP). The latter will prove important now that Mitra-Clip will be used more often to treat secondary mitral valve replacement. We continue education and proctorship for transcaval access, which has been performed across the globe in over 1000 patients to date.